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Electrophysiological study in 2 children with transient hypohidrosis induced by topiramate
Lucia Margari1, Patrizia Ventura, Maura Buttiglione
1Child Neurological and Psychiatric Service, Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy. l.margari@neurol.uniba.it
Insights
Topiramate can cause hypohidrosis (reduced sweating) in children by temporarily blocking sweat glands, not by affecting nerves. Symptoms resolve after discontinuing the anticonvulsant medication.
Area of Science:
- Neurology
- Pediatrics
- Pharmacology
Background:
- Topiramate is an anticonvulsant with a broad spectrum of activity.
- Hypohidrosis and hyperthermia are rare, reversible adverse effects of topiramate, primarily observed in children.
Observation:
- This study investigated the mechanism of topiramate-induced hypohidrosis in two pediatric patients.
- Neurophysiological assessments were conducted during and after topiramate treatment.
Findings:
- Electrophysiological studies revealed normal sensory nerve function (beta and delta fibers).
- Sympathetic skin responses were absent during topiramate treatment but normalized upon discontinuation.
- The findings suggest a direct effect on sweat glands rather than peripheral nerve involvement.
Implications:
- Topiramate may induce a transient blockade of carbonic anhydrase in sweat glands.
- This mechanism explains hypohidrosis without peripheral nervous system involvement.
- Understanding this adverse effect is crucial for managing pediatric patients on topiramate.
Objective:
Hypohidrosis, often associated with hyperthermia, has been reported, mostly in children, as a rare and reversible adverse effect of topiramate, an anticonvulsant drug with a broad spectrum of antiepileptic activity. The aim of our study is to detect a possible skin innervation involvement as the mechanism underlying hypohidrosis in children treated with topiramate.
Methods:
A neurophysiological study has been performed on 2 children who have developed hypohidrosis under topiramate treatment. Electrophysiological data have been recorded during topiramate treatment and compared with a control group. Sympathetic skin responses have been recorded during topiramate assumption and after its discontinuation.
Results:
In our 2 cases with hypohidrosis related to topiramate, electrophysiological study showed normal function of both beta and delta sensory fibers and absent sympathetic skin responses that recovered to normal after topiramate discontinuation.
Conclusions:
Our findings confirm that topiramate might induce a transitory specific carbonic anhydrase block at the level of sweat glands, without involvement of peripheral nervous system.
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